How Does Archiving Drug Policies Impact Health Plans?

According to research presented at AMCP 2021, archiving drug policies may increase utilization and cost to the plan, however, the archival of these policies can also produce a relief of administrative burden and costs associated with pre-authorization reviews and costly appeals.  

“When policies are archived, the benefits are seen in member access, administrative burden and administrative costs, ideally without significant effects on drug spend,” wrote researchers. “Once a drug policy is archived, it is then monitored for its impact on drug utilization and cost to ensure the archival continues to be appropriate.” 

In order to better understand whether health plans were impacted by archived drug policies, including unanticipated increases in utilization and costs to the plan, a team of researchers conducted a retrospective analysis of commercial pharmacy and medical claims data. They reviewed drugs corresponding to archived drug policies.

The following was included in the final evaluation on whether an archival was appropriate: 

• shift of utilization and spend from the drug(s) corresponding to archived policies to other drug products;
• the impact of utilization from changes to clinical guidelines;
• history of member abrasion;
• unnecessary barriers to care;
• impact of trade strategies; and
• other possible factors. 

According to the results, roughly 5813 annual pre-authorization requests were removed from the system. The researchers said that these were removed as a result of the archival of the selected policies. Further, it was found that the archrivals produced roughly $164,665 in annual administrative cost savings based on the cost of first review. This did not include appeals.  

“Although increases in utilization and cost to the plan were observed for many policies deemed appropriately archived, it was determined that the clinical benefits and the reduction in provider, member, and administrative burden offset the increases in cost to the plan,” they wrote.  

“The archival of drug policies can produce a relief of administrative burden and costs associated with PA reviews and costly appeals. This relief is especially critical for redirecting PA resources to a steady stream of novel specialty and rare disease drugs coming to the market.”  

—Julie Gould  

Reference:

Quach D, Radkey C. Evaluating the impact of archiving drug policies on utilization of medication and cost to plan. Poster presented at: AMCP 2021, April 12-16, 2021; Virtual.